Individual
DR. G. GAVIN GERONDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4901 CALHOUN RD, HOUSTON, TX 77204-2020
(713) 743-2659
(713) 743-6541
Mailing address
4901 CALHOUN RD, ROOM 2107, HOUSTON, TX 77204-2020
(713) 743-2659
(713) 743-6541
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3469TG
TX
174400000X
Specialist
03469TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
093458003
—
TX
05
—
1124091-04
—
TX
Enumeration date
06/17/2006
Last updated
05/27/2016
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